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GHANA DEMOGRAPHIC AND HEALTH SURVEY 1998
WOMEN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME ____
REGION ____
EA NUMBER ____
STRUCTURE NUMBER ____
HOUSEHOLD NUMBER _____

TYPE __

Men's Questionnaire 1
Women's Questionnaire 2

NAME OF HOUSEHOLD HEAD ______

NAME AND LINE NUMBER OF WOMAN _____

(For Office Use)

CITY/TOWN/VILLAGE _____

Large city 1
Medium city 2
Small city 3
Town 4
Village 5

INTERVIEW 1
DATE ___
INTERVIEWER'S NAME ___
RESULT* ___

NEXT VISIT:
DATE ___
TIME ___

INTERVIEW 2
DATE ____
INTERVIEWER'S NAME ___
RESULT* ___

NEXT VISIT:
DATE ___
TIME ___

INTERVIEW 3
DATE ___
INTERVIEWER'S NAME ___
RESULT*___

FINAL VISIT
DAY___
MONTH ___
YEAR _19__
NAME ___

RESULT ___

TOTAL NUMBER OF VISITS ___

Result __
**RESULT CODES:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 OTHER (SPECIFY) ____

LANGUAGE OF QUESTIONNAIRE** _1__

NATIVE LANGUAGE OF RESPONDENT**___

LANGUAGE OF INTERVIEW**___

TRANSLATOR USED

YES 1
NO 2

**LANGUAGE CODES

1 ENGLISH
2 AKAN
3 GA
4 EWE
5 HAUSA
6 DAGBANI
7 OTHER (SPECIFY) ____

SUPERVISOR
NAME ____
DATE ____

FIELD EDITOR
NAME ___
DATE ___

OFFICE EDITOR
______

KEYED BY
_______

SECTION 1. RESPONDENT'S BACKGROUND

100. RECORD THE TIME.

HOUR ___
MINUTES ___

101. COLLECT ANY RELEVANT DOCUMENTS THAT MAY HAVE INFORMATION ON THE RESPONDENT'S AGE AND HER CHILDREN'S AGE AND IMMUNIZATION.

102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a village?

CITY 1
TOWN 2
VILLAGE 3

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR ENTER '00'.

YEARS ___
ALWAYS (SINCE BIRTH) 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in a city, in a town, or in a village?

CITY 1
TOWN 2
VILLAGE 3

105. In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR 19__
DON'T KNOW YEAR 98

106. How old were you at your last birthday?

AGE IN COMPLETED YEARS ___

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

108. What is the highest level of school you attended: primary, middle/jss, secondary/sss, or higher?

PRIMARY 1
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4

109. What is the highest grade you completed at that level?

GRADE ___

110. CHECK 108:

PRIMARY OR MIDDLE/JSS ___ (GO TO 111)
SECONDARY/SSS AND HIGHER ___ (GO TO 112)

111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)

112. Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

113. Do you usually listen to a radio every day?

YES 1
NO 2

114. Do you usually watch television at least once a week?

YES 1
NO 2

115. What is your religion?

CATHOLIC 1
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
SPIRITUALIST 05
OTHER CHRISTIAN 06
MOSLEM 07
TRADITIONAL 08
NO RELIGION 09
OTHER (SPECIFY) ___ 96

116. To which ethnic group do you belong?

ASANTE 01
AKWAPIM 02
FANTE 03
OTHER AKAN 04
GA/ADANGBE 05
EWE 06
GUAN 07
MOLE-DAGBANI 08
GRUSSI 09
GRUMA 10
HAUSA 11
OTHER (SPECIFY) ____ 96

SECTION 2. REPRODUCTION

Now I would like to talk to you about all the pregnancies that you have had in your lifetime. By this I mean all the children born to you, whether they were born alive or dead, whether still living or not, whether living with you or elsewhere, and all the pregnancies that you have had that did not result in a live birth.

I understand that is not easy to talk about children who have died, or pregnancies that have terminated before full term, but it is extremely important that you tell us about all of them, so that we can develop programs that would help the Government of Ghana improve children's health in the future.

201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

202. Do you have any sons or daughters to whom you have given birth who are living with you?

YES 1
NO 2 (GO TO 204)

203. How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME ____
DAUGHTERS AT HOME ____

204. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

206. Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (GO TO 208)

207. In all, how many boys have died? And how many girls have died?
IF NONE RECORD '00'.

BOYS DEAD __
GIRLS DEAD __

208. Women sometimes have pregnancies that do not result in a live born child. That is, a pregnancy can end early, in a miscarriage, or the child can be born dead. Have you had any such pregnancy that did not result in a live birth?

YES 1
NO 2 (GO TO 210)

209. In all, how many such pregnancies have there been?

PREGNANCY LOSSES ___

210. SUM ANSWERS TO 203, 205, 207 AND 209 AND ENTER TOTAL.
IF NONE, RECORD '00'.

TOTAL ___

211. CHECK 210:
Just to make sure that I have this right: you have had in TOTAL ____ pregnancies during your life. Is that correct?

YES __ (GO TO 212)
NO __ (PROBE AND CORRECT 201-210 AS NECESSARY)

212. CHECK 210:

ONE OR MORE PREGNANCIES (GO TO 213)
NO PREGNANCIES (GO TO 234)

213. Now I would like to ask you about all of your pregnancies, whether born alive, born dead, or lost pregnancy, starting with the first one you had.

RECORD ALL THE PREGNANCIES. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF THERE ARE MORE THAN 11 PREGNANCIES, USE ADDITIONAL QUESTIONNAIRES.

214. Think back to the time of your (first/next) pregnancy.

215. Was that a single or multiple pregnancy?

SINGLE 1
MULTIPLE 2

216. Was the baby born alive, born dead, or did you lose this pregnancy?

BORN ALIVE 1 (GO TO 218)
BORN DEAD 2
LOST PREGNANCY 3 (GO TO 225)

217. Did that baby cry, move or breathe when it was born?

YES 1
NO 2 (GO TO 225)

218. What was the name given to that child?

(NAME) _____

219. Is (NAME) a boy or a girl?

BOY 1
GIRL 2

220. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season/significant event was he/she born?

MONTH ___
YEAR ____

221. Is (NAME) still alive?

YES 1
NO 2 (GO TO 224)

IF BORN ALIVE AND STILL LIVING:

222. How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.

AGE IN COMPLETED YEARS _____

223. Is (NAME) living with you?

YES 1
NO 2 (GO TO NEXT PREGNANCY)

IF BORN ALIVE BUT NOW DEAD:

224. How old was (NAME) when he/she died?

IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___ (GO TO NEXT PREGNANCY)

IF BORN DEAD OR LOST PREGNANCY:

225. In what month and year did this pregnancy end?

MONTH ___
YEAR _____

226. How many months did the pregnancy last?
RECORD IN COMPLETED MONTHS.

MONTHS ___

227. FROM YEAR OF THIS PREGNANCY SUBTRACT YEAR OF PREVIOUS PREGNANCY. IS THE DIFFERENCE 3 OR MORE YEARS?

YES 1
NO 2 (NEXT PREGNANCY)

228. Were there any other pregnancies between the previous pregnancy mentioned and this pregnancy?

YES 1
NO 2

230. FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST PREGNANCY.
IS THE DIFFERENCE 3 YEARS OR MORE?

YES 1
NO 2 (GO TO 232)

231. Have you had any pregnancies since the last pregnancy mentioned?
IF YES, PROBE AND CORRECT Q. 214 TO Q. 228 IF NECESSARY.

YES 1
NO 2

232. COMPARE 210 WITH NUMBER OF PREGNANCIES IN HISTORY ABOVE AND MARK:

NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
NUMBERS ARE SAME:
CHECK:
FOR EACH PREGNANCY: YEAR IS RECORDED IN 220 OR 225. __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED IN 222. __
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED IN 224. __
FOR EACH PREGNANCY LOSS: DURATION IS RECORDED IN 226. __
FOR AGE AT DEATH 12 MONTHS OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. __

233. CHECK 220 AND 225 AND ENTER THE NUMBER OF PREGNANCIES SINCE JANUARY 1993. IF NONE, RECORD '0'.

___

233A. CHECK 220 AND 221 AND ENTER THE NUMBER OF LIVING CHILDREN SINCE JANUARY 1993. IF NONE, RECORD '0'.

___

233B. CHECK 216 AND 217 AND ENTER THE NUMBER OF CHILDREN BORN ALIVE SINCE JANUARY 1993. IF NONE, RECORD '0'.

___

234. Are you pregnant?

YES 1
NO 2 (GO TO 237)
UNSURE 8 (GO TO 237)

235. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS ___

236. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

237. When did you last menstrual period start?

DATE, IF GIVEN ________
DAYS AGO 1 ___
WEEKS AGO 2 __
MONTHS AGO 3 ____
YEARS AGO 4 ___

IN MENOPAUSE 994
BEFORE LAST PREGNANCY 995
NEVER MENSTRUATED 996

SECTION 3. CONTRACEPTION

301. Now I would like to talk about the various ways or methods that a couple can use to delay or avoid pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.

THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302 AND 303.

301. Which ways or methods have you heard about?
READ DESCRIPTION OF EATH METHOD.

01) PILL Women can take a pill every day.
YES 1
NO 2
02) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03) INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04) NORPLANT Women can have several small rods placed in their upper arms by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
05) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside themselves before intercourse.
YES 1
NO 2
06) CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION Women can have an operation to avoid having anymore children.
YES 1
NO 2
08) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
09) RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
12) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
1 (SPECIFY) _____
2 (SPECIFY) _____

302. Have you and your husband/partner ever used (METHOD)?

01) PILL Women can take a pill every day.
YES 1
NO 2
02) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03) INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04) NORPLANT Women can have several small rods placed in their upper arms by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
05) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside themselves before intercourse.
YES 1
NO 2
06) CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
08) MALE STERILIZATION Men can have an operation to avoid having any more children: Has your husband/partner ever had an operation to avoid having children?
YES 1
NO 2
09) RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
12) OTHER METHODS
OTHER METHOD ONE
YES 1
NO 2
OTHER METHOD TWO
YES 1
NO 2

303. Do you know where a person could go to get (method)?

01) PILL Women can take a pill every day.
YES 1
NO 2
02) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03) INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04) NORPLANT Women can have several small rods placed in their upper arms by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
05) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside themselves before intercourse.
YES 1
NO 2
06) CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION Women can have an operation to avoid having anymore children.
YES 1
NO 2
08) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
09) RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant: Do you know where a person can go to obtain advice o how to use periodic abstinence?
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM) Do you know where a person can go to obtain advice on LAM?
YES 1
NO 2

304. CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (GO TO 305)
AT LEAST ONE "YES" (EVER USED) (GO TO 307)

305. Have you ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 329B)

306. What have you used or done?
CORRECT 302-303 (AND 301 IF NECESSARY).

307. Now I would like to ask you about the time when you first did something or used a method to avoid getting pregnant.

How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ___

308. When you first used family planning, did you want to have another child but at a later time, or did you not want to have another child at all?

WANTED CHILD LATER 1
DID NOT WANT ANOTHER CHILD 2
OTHER (SPECIFY) ____ 6

309. CHECK 302:

WOMAN NOT STERILIZED __ (GO TO 310)
WOMAN STERILIZED __ (GO TO 314A)

310. CHECK 234

NOT PREGNANT OR UNSURE __ (GO TO 313)
PREGNANT __ (GO TO 329)

313. Are you or your husband/partner currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 329)

314. Which method are you using?

314A. CIRCLE '07' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 324)
INJECTIONS 03 (GO TO 324)
NORPLANT 04 (GO TO 324)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 324)
CONDOM 06 (GO TO 324)
FEMALE STERILIZATION 07 (GO TO 318)
MALE STERILIZATION 08 (GO TO 318)
PERIODIC ABSTINENCE 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 324)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 324)
OTHER (SPECIFY) ____ 96 (GO TO 324)

315A. At the time you first started using the pill, did you consult a doctor, nurse, midwife, or a pharmacist?

YES 1
NO 2

315B. At the time you last got the pills, did you consult a doctor, nurse, midwife, or pharmacist?

YES 1
NO 2

315C. May I see the package of pills you are using now?
RECORD NAME OF BRAND.

PACKAGE SEEN 1 (GO TO 317)
BRAND NAME ___ (GO TO 317)
PACKAGE NOT SEEN 2

316. Do you know the brand name of the pills you are using now?
RECORD NAME OF BRAND.

BRAND NAME ___
DON'T KNOW 98

317. How much did you pay for the pills the last time you go them?

CEDIS ___
FREE 9996
DON'T KNOW 9998

317A. How many cycles of pills did you get the last time?

NUMBER OF CYCLES __
DON'T KNOW 8

317B. Have you experienced any side effects from the use of the pill?

YES 1
NO 2 (GO TO 324)

317C. What side effects have you experienced?
CIRCLE ALL MENTIONED.

DIZZINESS A (GO TO 324)
WEIGHT GAIN B (GO TO 324)
HEADACHES C (GO TO 324)
EXCESSIVE BLEEDING D (GO TO 324)
IRREGULAR CYCLE E (GO TO 324)
PAINFUL PERIOD/CRAMPS F (GO TO 324)
PALPITATION/IRRECULAR HEART BEAT G (GO TO 324)
OTHER (SPECIFY) ___ (GO TO 324)

318. Where did the sterilization take place?

IF SOURCE IS HOSPITAL, HELATH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _________
PUBLIC SECTOR
GVT. HOSPITAL/POLYCLINIC 11
GVT. HEALTH CENTRE 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY) ____ 16
PRIVATE SECTOR
HOSPITAL/CLINIC 21
MOBILE CLINIC 25
FP/PPAG CLINIC 27
MATERNITY HOME 28
OTHER PRIVATE (SPECIFY) ____ 29
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

319. Do you regret that (you/your husband/partner) had the operation not to have any (more) children?

YES 1
NO 2 (GO TO 321)

320. Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 01
SPOUSE WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY) ____ 96

321. In what month and year was the sterilization performed?
IF DON'T KNOW YEAR PROBE: How many years ago?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 325)
DON'T KNOW YEAR 9998

321A. How old were you at the time of sterilization?

AGE IN COMPLETED YEARS ___ (GO TO 325)

323. How do you determine which days of your monthly cycle not to have sexual relations?

BASED ON CALENDAR 01
BASED ON BODY TEMPERATURE 02
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03
BASED ON BODY TEMPERATURE AND CERVICAL MUCUS 04
NO SPECIFIC SYSTEM 05
OTHER (SPECIFY) ____ 96

324. For how many months have you been using (METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS ___
8 YEARS OR LONGER 96

325. CHECK 314.
CIRCLE METHOD CODE:

PILL 01
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 327A)
MALE STERILIZATION 08 (GO TO 327A)
PERIODIC ABSTINENCE 09 (GO TO 330)
WITHDRAWAL 10 (GO TO 330)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 326A)
OTHER (SPECIFY) ____ 96 (GO TO 330)

326. Where did you obtain (METHOD) the last time?
326A. Where did you learn how to use the Lactational Amenorrhea Method?

IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _____
PUBLIC SECTOR
GVT. HOSPITAL/POLYCLINIC 11
GVT. HEALTH CENTRE 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14 (GO TO 327)
FIELD WORKER 15 (GO TO 327)
OTHER PUBLIC (SPECIFY) ____ 16 (GO TO 327)
PRIVATE SECTOR
HOSPITAL/CLINIC 21
PHARMACY 22
CHEMIST 23
DRUG STORE 24
MOBILE CLINIC 25 (GO TO 327)
FIELD WORKER 26 (GO TO 327)
FP/PPAG CLINIC 27
MATERNITY HOME 28
OTHER PRIVATE (SPECIFY) ____ 29
OTHER SOURCE
CHURCH 31
SHOP 32
FRIEND/RELATIVE 33 (GO TO 327)
OTHER (SPECIFY) ____ 36 (GO TO 327)

326B. How long does it usually take to travel from your home to this place?

MINUTES ___
DON'T KNOW 998

326C. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2
DON'T KNOW 8

327. Do you know another place where you could have obtained (METHOD) the last time?

YES 1
NO 2 (GO TO 401)

327A. At the time of the sterilization operation, did you know another place where you could have received the operation?

YES 1
NO 2 (GO TO 401)

328. People select the place where they get family planning services for various reasons.
What was the main reason you went to (NAME OF PLACE IN Q. 326 or Q. 318) instead of the other place you know about?

RECORD RESPONSE AND CIRCLE CODE _____

ACCESS-RELATED REASONS
CLOSER TO HOME 11 (GO TO 401)
CLOSER TO MARKET/WORK 12 (GO TO 401)
AVAILABILITY OF TRANSPORT 13 (GO TO 401)
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/FRIENDLY 21 (GO TO 401)
CLEANER FACILITY 22 (GO TO 401)
OFFERS MORE PRIVACY 23 (GO TO 401)
SHORTER WAITING TIME 24 (GO TO 401)
LONGER HRS OF SERVICE 25 (GO TO 401)
USE OTHER SERVICES AT THE FACILITY 26 (GO TO 401)
LOWER COST/CHEAPER 31 (GO TO 401)
WANTED ANONYMITY 41 (GO TO 401)
OTHER (SPECIFY) ____ 96 (GO TO 401)
DON'T KNOW 98 (GO TO 401)

329. What was the last method of family planning you or your husband/partner used?

PILL 01
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
LACTATIONAL AMENORRHEA METHOD 11
OTHER (SPECIFY) ____ 96

329A. For how many months did you use the method continuously?

____

329B. What is the main reason you are not using a method of contraception to avoid pregnancy?

FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
PREGNANT 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND/PARTNER OPPOSED 32
OTHER OPPOSED 33
RELIGIOUS PROHIBIITON 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 401)
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NATURAL PROCESS 56
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

330. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 401)

331. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _______
PUBLIC SECTOR
GVT. HOSPITAL/POLYCLINIC 11
GVT. HEALTH CENTRE 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ____ 16
PRIVATE SECTOR
HOSPITAL/CLINIC 21
PHARMACY 22
CHEMIST 23
DRUG STORE 24
MOBILE CLINIC 25
FIELD WORKER 26
FP/PPAG CLINIC 27
MATERNITY HOME 28
OTHER PRIVATE (SPECIFY) ____ 29
OTHER SOURCE
CHURCH 31
SHOP 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) ______ 36

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 233:

ONE OR MORE PREGNANCIES SINCE JANUARY 1993 (GO TO 402)
NO PREGNANCIES SINCE JANUARY 1993 OR Q. 233 IS BLANK (GO TO 465)

402. ENTER THE PREGNANCY LINE NUMBER, NAME (IF LIVE BIRTH), AND SURVIVAL STATUS (IF LIVE BIRTH) OF EACH PREGNANCY SINCE JANUARY 1993 IN THE TABLE.

ASK THE QUESTIONS ABOUT ALL OF THESE PREGNANCIES. BEGIN WITH THE LAST PREGNANCY.

(IF THERE ARE MORE THAN 3 PREGNANCIES, USE ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about all your pregnancies in the last five years. We will talk about each separately.

403. LINE NUMBER FROM Q214.

LINE NUMBER ___

404. FOR LIVE BIRTHS ONLY: NAME FROM Q.218 AND SURVIVAL STATUS FROM Q.221.

ALIVE __ (GO TO 405)
DEAD __ (GO TO 405)

405. At the time you became pregnant (with NAME), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

THEN 1 (GO TO 407)
LATER 2
NO MORE 3 (GO TO 407)

406. At the time you became pregnant (with NAME) how much longer would you like to have waited?

MONTHS 1 __
YEARS 2 __
DON'T KNOW 998

407. When you were pregnant (with NAME), did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPES OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED TRADTIONAL BIRTH ATTENDANT D
UNTRAINED TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) ____ X
NO ONE Y (GO TO 410)

407A. Were you given an antenatal ID card for this pregnancy?

YES 1
NO 2
DON'T KNOW 8

408. How many months pregnant were you when you first received antenatal care?

MONTHS __
DON'T KNOW 98

408A. How many months pregnant were you at your last antenatal visit?

MONTHS __
DON'T KNOW 98

408B. During this pregnancy, did you have any of the following performed at least once during any of your antenatal visits?

Weight measured?
Height measured?
Blood pressure measured?
Urine tested?
Blood tested?

WEIGHT MEASURED
YES 1
NO 2
HEIGHT MEASURED
YES 1
NO 2
BLOOD PRESSURE MEASURED
YES 1
NO 2
URINE TESTED
YES 1
NO 2
BLOOD TESTED
YES 1
NO 2

409. How many times did you receive antenatal care during this pregnancy?

NO. OF TIMES __
DON'T KNOW 98

410. When you were pregnant (with NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 412A)
DON'T KNOW 8 (GO TO 412A)

411. During this pregnancy, how many times did you get this injection?

NO. OF TIMES ___
DON'T KNOW 8

412A. When you were pregnant (with NAME) did you receive any iron tablets?
SHOW IRON TABLETS.

YES 1
NO 2
DON'T KNOW 8

412B. When you were pregnant (with NAME) did you receive folic/folate acid tablets?
SHOW FOLIC/FOLATE ACID TABLETS.

YES 1
NO 2
DON'T KNOW 8

LAST BIRTH

IF LIVE BIRTH CONTINUE WITH Q. 413, IF OTHER PREGNANCY, GO BACK TO Q. 405 IN NEXT COLUMN, OR IF NOW MORE PREGNANCIES, GO TO Q. 439.

NEXT-TO-LAST BIRTH
IF LIVE BIRTH CONTINUE WITH Q. 413, IF OTHER PREGNANCY, GO BACK TO Q. 405 IN NEXT COLUMN, OR IF NOW MORE PREGNANCIES, GO TO Q. 439.

SECOND-FROM-LAST BIRTH
IF LIVE BIRTH CONTINUE WITH Q. 413, IF OTHER PREGNANCY, GO BACK TO Q. 405 IN NEXT COLUMN; OR IF NO MORE PREGNANCIES, GO TO Q. 439.

413.Where did you go to give birth to (NAME)?

HOME
RESP'S HOME 11
TBA'S HOME 12
OTHER HOME 13
PUBLIC SECTOR
GVT. HOSPITAL/CLINIC 21
GVT. HEALTH CENTRE 22
GVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY)______ 26
PRIVATE SECTOR
HOSPITAL/CLINIC 31
MATERNITY HOME 32
OTHER PRIVATE (SPECIFY)______ 36
OTHER (SPECIFY) ____ 96

414. Who assisted with the delivery of (NAME)?
Anyone else?

PROBE FOR THE TYPE OF PERSONS AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT D
UNTRAINED TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) _____ X
NO ONE Y

415. How was (NAME) delivered: normal, caesarian, or other?

NORMAL 1
CAESARIAN 2
OTHER (SPECIFY) _____ 3
DON'T KNOW 8

416. When (NAME) was born, was he/she: very large, large, average, small, or very small?

VERY LARGE 1
LARGE 2
AVERAGE 3
SMALL 4
VERY SMALL 5
DON'T KNOW 8

417. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 417B)

417A. How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.

KILOGRAM FROM CARD 1 __.__
KILOGRAM FROM RECALL 2 __.__
DON'T KNOW 998

417B. In the six weeks after (NAME) was born, did anyone check on your health or the health of your baby?

YES 1
NO 2 (GO TO 417G)

417C. How many days or weeks after the delivery did the first visit take place?
RECORD '00' DAYS IF SAME DAY.

DAYS 1 __
WEEKS 2 __
DON'T KNOW 98

417D. Who checked on your health or the health of your baby at that time? Anyone else?
PROBE FOR THE TYPE OF PERSONS AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT D
UNTRAINED TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) _____ X

417E. Where did this first check-up take place?

HOME
RESP. HOME 11
TBA'S HOME 12
OTHER HOME 13
PUBLIC SECTOR
GVT. HOSPITAL/CLINIC 21
GVT. HEALTH CENTRE 22
GVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____ 26
PRIVATE SECTOR
HOSPITAL/CLINIC 31
MATERNITY HOME 32
OTHER PRIVATE (SPECIFY) ____ 36
OTHER (SPECIFY) _____

417F. During this visit, did the health worker give you advice about any of the following?

New-born care?
Breastfeeding?
Complementary feeding?
Vitamins?
Immunizations?
Delivery complications?
Family planning?

NEW-BORN CARE
YES 1
NO 2
BREASTFEEDING
YES 1
NO 2
COMPL. FEEDING
YES 1
NO 2
VITAMINS
YES 1
NO 2
IMMUNIZATIONS
YES 1
NO 2
DELV. COMPLICATIONS
YES 1
NO 2
FAMILY PLANNING
YES 1
NO 2

417G. Did you receive Vitamin A capsules within six weeks following the delivery of (NAME)?
SHOW VITAMIN A CAPSULE.

YES 1
NO 2

418. Has your period returned since the birth of (NAME)? (LAST BIRTH ONLY)
[Most recent birth within the last five years]

YES 1 (GO TO 420)
NO 2 (GO TO 421)

419. Did your period return between the birth of (NAME) and your next pregnancy?
[Repeat questions for all children born in the last 5 years, excluding the most recent birth]

YES 1
NO 2 (GO TO 423)

420. For how many months after the birth of (NAME) did you not have a period?

MONTHS ___
DON'T KNOW 98

421. CHECK 234: RESPONDENT PREGNANT?
LAST BIRTH ONLY

NOT PREGNANT __ (GO TO 422)
PREGNANT OR UNSURE __ (GO TO 423)

422. Have you resumed sexual relations since the birth of (NAME)?
[Most recent birth within the last five years]

YES 1
NO 2 (GO TO 424)

423. For how many months after the birth of (NAME) did you not have sexual relations?

MONTHS __
DON'T KNOW 98

424. Did you ever breastfeed (NAME)?

YES 1 (GO TO 425)
NO 2

424A. Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 01 (GO TO 430)
CHILD ILL/WEAK 02 (GO TO 430)
CHILD DIED 03 (GO TO 430)
NIPPLE/BREAST PROBLEM 04 (GO TO 430)
INSUFFICIENT MILK 05 (GO TO 430)
MOTHER WORKING 06 (GO TO 430)
CHILD REFUSED 07 (GO TO 430)
OTHER (SPECIFY) ____ 96 (GO TO 430)

425. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1 __
DAYS 2 __

426. CHECK 404: CHILD ALIVE?
[Most recent birth within the last five years]

ALIVE __ (GO TO 427)
DEAD __ (GO TO 428)

427. Are you still breastfeeding (NAME)?
[Most recent birth within the last five years]

YES 1 (GO TO 431)
NO 2

428. For how many months did you breastfeed (NAME)?

MONTHS ___
DON'T KNOW 98

429. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) ____ 96

430. CHECK 404:
CHILD ALIVE?

ALIVE __ (GO TO 433)
DEAD __ (GO BACK TO 405 IN NEXT COL. OR, IF NO MORE BIRTHS, GO TO 439)

431. How many times did you breastfeed (NAME) last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER. (LAST BIRTH)
[Most recent birth within the last five years]

NUMBER OF NIGHTTIME FEEDINGS ___

432. How many times did you breastfeed (NAME) yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER. (LAST BIRTH)
[Most recent birth within the last five years]

NUMBER OF DAYLIGHT FEEDINGS _____

433. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?

YES 1
NO 2
DON'T KNOW 8

434. At any time yesterday or last night, was (NAME) given any of the following?

Plain water?
Sugar water?
Juice?
Baby formula?
Tinned/powdered/fresh milk?

Any other liquid?
Any solid or mushy food made from maize, rice, yam, weanimix, mpotompoto, or other grain/tuber?
Eggs, fish or poultry?
Meat?
Any other solid or semi-solid foods?

PLAIN WATER
YES 1
NO 2
DK 8
SUGAR WATER
YES 1
NO 2
DK 8
JUICE
YES 1
NO 2
DK 8
BABY FORMULA
YES 1
NO 2
DK 8
TINNED/POWDERED FRESH MILK
YES 1
NO 2
DK 8
OTHER LIQUIDS
YES 1
NO 2
DK 8
FOOD MADE FROM GRAIN/TUBER
YES 1
NO 2
DK 8
EGGS/FISH/POULTRY
YES 1
NO 2
DK 8
MEAT
YES 1
NO 2
DK 8
OTHER SOLID/SEMI-SOLID FOODS
YES 1
NO 2
DK 8

435. CHECK 434:
FOOD OR LIQUID GIVEN YESTERDAY?

"YES" TO ONE/MORE __ (GO TO 436)
"NO/DK" TO ALL __ (GO TO 439)

436. (Apart from breastfeeding,) how many times did (NAME) eat yesterday, including both meals and snacks?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

438. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 439.

SECTION 4B. IMMUNIZATION AND HEALTH

439 CHECK 233A:

ONE OR MORE LIVING CHILDREN BORN SINCE JANUARY 1993 __ (GO TO 439A)
NO LIVING CHILDREN BORN SINCE JANUARY 1993 __ (GO TO 465)

439A. ENTER THE LINE NUMBER AND NAME OF EACH LIVING CHILD BORN SINCE JANUARY 1993 IN THE TABLE.

ASK THE QUESTIONS ABOUT ALL OF THESE CHILDREN. BEGIN WITH THE YOUNGEST CHILD.
(IF THERE ARE MORE THAN 3 LIVING CHILDREN, USE ADDITIONAL QUESTIONNAIRES).

440. LINE NUMBER FROM Q214.

LINE NUMBER ___

441. NAME FROM Q218.

NAME _______

442. Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?

YES, SEEN 1 (GO TO 444)
YES, NOT SEEN 2 (GO TO 446)
NO CARD 3

443. Did you ever have a vaccination card for (NAME)?

YES 1 (GO TO 446)
NO 2

444. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.

(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN BUT NO DATE IS RECORDED.

BCG
DAY __
MONTH __
YEAR __
POLIO 0
DAY __
MONTH __
YEAR __
POLIO 1
DAY __
MONTH __
YEAR __
POLIO 2
DAY __
MONTH __
YEAR __
POLIO 3
DAY __
MONTH __
YEAR __
DPT 1
DAY __
MONTH __
YEAR __
DPT 2
DAY __
MONTH __
YEAR __
DPT 3
DAY __
MONTH __
YEAR __
MEASLES
DAY __
MONTH __
YEAR __
YELLOW FEVER
DAY __
MONTH __
YEAR __

445. Has (NAME) received any vaccinations that are not recorded on this card?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO, 0-3, DPT 1-3, MEASLES AND/OR YELLOW FEVER VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 444) (GO TO 448)
NO 2 (GO TO 448)
DON'T KNOW 8 (GO TO 448)

446. Did (name) ever receive any vaccinations to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 448)
DON'T KNOW 8 (GO TO 448)

447. Please tell me if (NAME) received any of the following:

447A. A BCG vaccinations against tuberculosis, that is, an injection in the arm that caused a scar?

YES 1
NO 2
DON'T KNOW 8

447B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 447E)
DON'T KNOW 8 (GO TO 447E)

447C. How many times?

NUMBER OF TIMES ___

447D. When was the first polio vaccine given, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

447E. DPT vaccination, that is, an injection usually given at the same time as polio drops?

YES 1
NO 2 (GO TO 447G)
DON'T KNOW 8 (GO TO 447G)

447F. How many times?

NUMBER OF TIMES___

447G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

447H. An injection to prevent yellow fever?

YES 1
NO 2
DON'T KNOW 8

448. During the last 6 months has (NAME) received Vitamin A capsules?
SHOW VITAMIN A CAPSULE.

YES 1
NO 2
DON'T KNOW 8

448A. At any time in the last 6 months did (NAME) receive any health related home visits?

YES 1
NO 2
DON'T KNOW 8

449. Has (NAME) been ill with a fever at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 450)
DON'T KNOW 8 (GO TO 450)

449B. What was given or done to treat the fever? Anything else?
RECORD ALL MENTIONED

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
SPONGING H
OTHER (SPECIFY) ___ X

449C. Did you seek advice or treatment for the fever?

YES 1
NO 2 (GO TO 450)

449D. Where did you seek advice or treatment? Anywhere else?
PROBE FOR ALL THAT IS MENTIONED. RECORD ALL MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PRIVATE SECTOR
HOSPITAL G
PHARMACY/DRUGSTORE/CHEMIST H
CLINIC I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE (SPECIFY) _____ L
OTHER SOURCE
SHOP M
TRAD. PRACTITIONER N
DRUG PEDDLER O
OTHER (SPECIFY) _____ X

450. Has (NAME) been ill with a cough at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)

451. When (NAME) was ill with a cough, did he/she breathe faster than usual with short, fast breaths?

YES 1
NO 2
DON'T KNOW 8

451A. Was anything given to treat the cough?

YES 1
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)

451B. What was given to treat the cough?

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
OTHER (SPECIFY) ____ H

452. Did you seek advice or treatment for the cough or difficult breathing?

YES 1
NO 2 (GO TO 454)

453. Where did you seek advice or treatment? Anywhere else?
PROBE FOR ALL THAT IS MENTIONED. RECORD ALL MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PRIVATE SECTOR
HOSPITAL G
PHARMACY/DRUGSTORE/CHEMIST H
CLINIC I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE (SPECIFY) _____ L
OTHER SOURCE
SHOP M
TRAD. PRACTITIONER N
DRUG PEDDLER O
OTHER (SPECIFY) _____ X

454. Has (NAME) had diarrhea, that is, loose or watery stool in the last 2 weeks?

YES 1
NO 2 (GO TO 464)
DON'T KONW 8 (GO TO 464)

455. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

456. On the worst day of the diarrhea, how many bowel movements did (NAME) have?

NUMBER OF BOWEL MOVEMENTS ____
DON'T KNOW 98

457. Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

458. Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

460. Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 462)
DON'T KNOW 8 (GO TO 462)

461. What was given to treat the diarrhea?
Anything else?
RECORD ALL MENTIONED.

FLUID FROM ORS PACKET A
RECOMMENDED HOME FLUID B
PILL OR SYRUP C
INJECTION D
(I.V.) INTRAVENOUS E
SUGAR-SALT-WATER SOL. F
HOME REMEDIES/HERBAL MEDICINES G
OTHER (SPECIFY) _____ X

462. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 464)

463. Where did you seek advice or treatment? Anywhere else?
PROBE FOR ALL THAT IS MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PRIVATE SECTOR
HOSPITAL G
PHARMACY/DRUGSTORE/CHEMIST H
CLINIC I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE (SPECIFY) _____ L
OTHER SOURCE
SHOP M
TRAD. PRACTITIONER N
DRUG PEDDLER O
OTHER (SPECIFY) _____ X

464. LIVING CHILD
GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.

465. When a child has diarrhea, should he/she be given the same amount to drink, more or less than usual?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

466. When a child has diarrhea, should he/she be given the same amount to eat, more or less than usual?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

467. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) _____ X
DON'T KNOW Z

468. When a child is sick with a cough, what signs of illness would you tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

FAST BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
CHEST IN DRAWING E
UNABLE TO DRINK F
NOT EATING/NOT DRINKING WELL G
GETTING SICKER/VERY SICK H
NOT GETTING BETTER I
OTHER (SPECIFY) _____ X
DON'T KNOW Z

469. CHECK 461, ALL COLUMNS:

NO CHILD RECEIVED ORS OR QUESTION NOT ASKED ___ (GO TO 470)
ANY CHILD RECEIVED ORS ___ (GO TO 470B)

470. Have you ever heard of a special product called ORS you can get for treatment of diarrhea?

YES 1 (GO TO 470B)
NO 2

470A. Have you ever seen (a) packet(s) like this?
SHOW ORS PACKETS LIKELY TO BE USED IN THE LOCALITY OF THE INTERVIEW.

YES 1
NO 2 (GO TO 501)

471A. Did you prepare the whole packet at once or only part of the packet?

WHOLE PACKET AT ONCE 1
ONLY PART OF PACKET 2 (GO TO 472)

471B. How much water did you mix with a packet of ORS?

1/2 LITER 01
1 LITER 02
1 1/2 LITER 03
1 BEER BOTTLE 04
FOLLOWED PACKAGE INSTRUCTIONS 05
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

472. Where can you buy or obtain a packet of ORS? PROBE: Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PRIVATE SECTOR
HOSPITAL G
PHARMACY/DRUGSTORE/CHEMIST H
CLINIC I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE (SPECIFY) _____ L
OTHER SOURCE
SHOP M
TRAD. PRACTITIONER N
DRUG PEDDLER O
OTHER (SPECIFY) _____ X

SECTION 5. MARRIAGE

501. PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND/PARTNER
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

502. Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (GO TO 507)
YES, LIVING WITH A MAN 2 (GO TO 507)
NO, NOT IN UNION 3

503. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3

504. Have you ever been married or lived with a man?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 511)
NO 3 (GO TO 515)

506. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 511)
DIVORCED 2 (GO TO 511)
SEPARATED 3 (GO TO 511)

507. Is your husband/partner living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

507A. WRITE THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR HER HUSBAND/PARTNER. IF HUSBAND/PARTNER IS NOT LISTED WRITE '00'.

___

508. Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 511)

509. How many other wives does he have?

NUMBER ___
DON'T KNOW 98 (GO TO 511)

510. Are you the first, second, .... wife?

RANK___

511. Have you been married or lived with a man only once, or more than once?

ONCE 1
MORE THAN ONCE 2

512. CHECK 511:

MARRIED/LIVED WITH A MAN ONLY ONCE __ (In what month and year did you start living with your husband/partner?)

MARRIED/LIVED WITH A MAN MORE THAN ONCE __ (Now we will talk about your first husband/partner. In what month and year did you start living with him?)

MONTH ____
DON'T KNOW MONTH 98
YEAR 19___ (GO TO 514)
DON'T KNOW YEAR 9998

513. How old were you when you started living with him?

AGE ___

514. CHECK 511:

MARRIED/LIVED WITH A MAN ONLY ONCE __ (GO TO 515)

MARRIED/LIVED WITH A MAN MORE THAN ONCE __ (Now we will talk about your current husband/partner. In what month and year did you start living with him?)

MONTH ____
DON'T KNOW MONTH 98
YEAR 19___
DON'T KNOW YEAR 9998

515. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.

When was the last time you had sexual intercourse (if ever)?

NEVER 000 (GO TO 520)
DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
BEFORE LAST BIRTH 996

516. CHECK 301:

KNOWS CONDOM __ (The last time you had sex, was a condom used?)

DOES NOT KNOW CONDOM __ (Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?)

YES 1
NO 2
DON'T KNOW 8

517. Do you know of a place where you can get condoms?

YES 1
NO 2 (GO TO 519)

518. Where is that? Anywhere else?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. RECORD ALL MENTIONED.

NAME OF PLACE _____
PUBLIC SECTOR
GVT. HOSPITAL/POLYCLINIC A
GVT. HEALTH CENTRE B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PRIVATE SECTOR
HOSPITAL/CLINIC G
PHARMACY H
CHEMIST I
DRUG STORE J
MOBLIE CLINIC K
FIELD WORKER L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE (SPECIFY) ____O
OTHER SOURCE
CHURCH P
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) _____ S

519. How old were you when you first had sexual intercourse?

AGE __
FIRST TIME WHEN MARRIED 96

520. How old were you when you first had your menstrual period?

AGE __

SECTION 6. FERTILITY PREFERENCES

601. CHECK 314:

NEITHER STERILIZED __ (GO TO 602)
HE OR SHE STERILIZED __ (GO TO 612)

602. CHECK 234:

NOT PREGNANT OR UNSURE __ (Now I have some questions about the future. Would you like to (a/another) child, or would you prefer not to have any (more) children?)

PREGNANT __ (Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?)

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DON'T KNOW 8 (GO TO 604)

603. CHECK 234:

NOT PREGNANT OR UNSURE __ (How long would you like to wait form now before the birth of (a/another) child?)

PREGNANT __ (After the child you are expecting now, how long would you like to wait before the birth of another child?)

MONTHS 1 __
YEARS 2 __

SOON/NOW 996 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIGE 995
OTHER (SPECIFY) ___ 996
DON'T KNOW 998

604. CHECK 234:

NOT PREGNANT OR UNSURE __ (GO TO 605)
PREGNANT __ (GO TO 607)

605. If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 3

606. CHECK 314: USING A METHOD?

NOT ASKED __ (GO TO 607)
NOT CURRENTLY USING __ (GO TO 607)
CURRENTLY USING __ (GO TO 612)

607. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

YES 1 (GO TO 609)
NO 2
DON'T KNOW 8

608. Do you think you will use a method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2 (GO TO 610)
DON'T KNOW 8 (GO TO 610)

609. Which method would you prefer to use?

PILL 01 (GO TO 612)
IUD 02 (GO TO 612)
INJECTIONS 03 (GO TO 612)
IMPLANTS 04 (GO TO 612)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 612)
CONDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
PERIODIC ABSTINENCE 09 (GO TO 612)
WITHDRAWAL 10 (GO TO 612)
LACATIONAL AMENORRHEA METHOD 11 (GO TO 612)
OTHER (SPECIFY) _____ 96 (GO TO 612)
UNSURE 98 (GO TO 612)

610. What is the main reason that you think you will never use a method?

NOT CURRENTLY MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22 (GO TO 612)
MENOPAUSAL/WOMB REMOVED 23 (GO TO 612)
SUBFECUND/INFECUND 24 (GO TO 612)
WANTS MORE CHILDREN 26 (GO TO 612)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 612)
HUSBAND/PARTNER OPPOSED 32 (GO TO 612)
OTHERS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COST TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
OTHER (SPECIFY) ____ 96 (GO TO 612)
DON'T KNOW 98 (GO TO 612)

611. Would you ever use a method if you were married?

YES 1
NO 2
DON'T KNOW 8

612. CHECK 221:

HAS LIVING CHILDREN __ (If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?)

NO LIVING CHILDREN __ (If you could choose exactly the number of children to have in your whole life, how many would that be?)

PROBE FOR A NUMERIC RESPONSE.

NUMBER ___
OTHER (SPECIFY) ____ 96 (GO TO 614)

613. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?

NUMBER BOYS ____
UP TO GOD 95
OTHER (SPECIFY) ____ 96
NUMBER GIRLS ___
UP TO GOD 95
OTHER (SPECIFY) ____ 96
NUMBER EITHER ___
UP TO GOD 95
OTHER (SPECIFY) ____ 96

614. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NO OPINION 3

615. Is it acceptable or not acceptable to you for information on family planning to be provided:
On the radio? On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8

616. In the last few months have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2

618. In the last few months have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 620)

619. With whom? Anyone else?
RECORD ALL MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
OTHER (SPECIFY) ____ X

620. CHECK 502:

YES, CURRENTLY MARRIED __ (GO TO 621)
YES, LIVING WITH A MAN __ (GO TO 621)
NO, NOT IN UNION __ (GO TO 701)

621. Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.

Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

622. How often have you talked to your husband/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

623. Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

SECTION 7. HUSBAND'S/PARTNER'S BACKGROUND AND WOMAN'S WORK

701. CHECK 502 AND 504:

CURRENTLY MARRIED/LIVING WITH A MAN __ (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN __ (GO TO 703)
NEVER MARRIED AND NEVER IN UNION __ (GO TO 709)

702. How old was your husband/partner on his last birthday?

AGE __

703. Did your (last) husband/partner ever attend school?

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school he attended: primary, middle/jss, secondary/sss, or higher?

PRIMARY 1
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4
DON'T KNOW 8 (GO TO 706)

705. What was the highest grade he completed at that level?

GRADE __
DON'T KNOW 98

706. What (is/was) your (last) husband/partner's occupation?
That is, what kind of work (does/did) he mainly do?

_____________ __
_____________
_____________

707. CHECK 706:

WORKS (WORKED) IN AGRICULTURE __ (GO TO 708)
DOES (DID) NOT WORK IN AGRECULTURE __ (GO TO 709)

708. (Does/did) your husband/partner work mainly on his own land or on family land, or (does/did) he rent land, or (does/did) he work on someone else's land?

HIS LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

709. Aside from your own housework, are you currently working?

YES 1 (GO TO 712)
NO 2

710. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or any other work?

YES 1 (GO TO 712)
NO 2

711. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 801)

712. What is your occupation, that is, what kind of work do you mainly do?

____________ ___
____________
____________

713. CHECK 712:

WORKS IN AGRICULTURE __ (GO TO 714)
DOES NOT WORK IN AGRICULTURE __ (GO TO 715)

714. Do you work mainly on your own land or on family land, or do you rent land
or work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

715. Do you do this work for a member of your family, for someone else, or are you self-employed?

FAMILY MEMBER 1
SOMEONE ELSE 2
SELF-EMPLOYED 3

716. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1 (GO TO 718)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 719)

717. During the last 12 months, how many months did you work?

NUMBER OF MONTHS ___

718. During the last 12 months, how many days a week did you usually work (in the months that you worked)?

NUMBER OF DAYS __ (GO TO 720)

719. During the last 12 months, approximately how many days did you work?

NUMBER OF DAYS ___

720. Do you earn cash for your work?
PROBE: Do you make money for working?

YES 1
NO 2 (GO TO 723)

721. How much do you usually earn for this work?
PROBE: Is this by the day, by the week, or by the month?

PER HOUR 1_____
PER DAY 2 _____
PER WEEK 3_____
PER MONTH 4_____
PER YEAR 5_____
OTHER (SPECIFY) ______ 9999996

722. CHECK 502:

YES, CURRENTLY MARRIED YES, LIVING WITH A MAN __ (Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?)

NO, NOT IN UNION __ (Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?)

RESPONDENT DECIDES 1
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5

723. Do you usually work at home or away from home?

HOME 1
AWAY 2

724 .CHECK 222 AND 223:
IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

YES __ (GO TO 725)
NO __ (GO TO 801)

725. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

RESPONDENT 01
HUSBAND/PARTNER 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
OTHER RELATIVES 05
NEIGHBORS 06
FRIENDS 07
SERVANTS/HIRED HELP 08
CHILD IS IN SCHOOL 09
INSTITUTIONAL CHILD CARE 10
HAS NOT WORKED SINCE LAST BIRTH 95
OTHER (SPECIFY) ____ 96

SECTION 8. AIDS

801. Now I have a few questions about a very important topic. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 814)

802. From which sources of information have you learned most about AIDS? Any other sources?
RECORD ALL MENTIONED.

RADIO A
TELEVISION B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
SLOGANS/MUSIC E
HEALTH WORKERS F
CHURCHES/MOSQUES G
SCHOOLS/TEACHERS H
COMMUNITY MEETINGS I
FRIENDS/RELATIVES J
WORK PLACE K
OTHER (SPECIFY) ____ X

803. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 807)
DON'T KNOW 3 (GO TO 807)

804. What can a person do? Any other ways?
RECORD ALL MENTIONED.

SAFE SEX A
ABSTAIN FROM SEX B
USE CONDOM C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WTIH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID INFECTED NEEDLES I
AVOID KISSING J
AVOID MOSQUITO BITES K
AVOID SHARING INFECTED BLADES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
OTHER (SPECIFY) ____ W
OTHER (SPECIFY) ____ X
DON'T KNOW Z

805. CHECK 804:

MENTIONED SAFE SEX __ (GO TO 806)
DID NOT MENTION SAFE SEX __ (GO TO 807)

806. What does "safe sex" mean to you?

ABSTAIN FROM SEX A
USE CONDOMS B
HAVE ONLY ONE SEX PARTNER C
AVOID SEX WITH PROSTITUTES D
AVOID SEX WITH HOMOSEXUALS E
OTHER (SPECIFY) ____ X
DON'T KNOW Z

807. Is it possible for a healthy looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

808. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

809. Is it possible for a woman who has the AIDS virus to pass the virus to her child through breastfeeding?

YES 1
NO 2
DON'T KNOW 8

810. What do you suggest is the most important thing the government should do for people who have AIDS?

PROVIDE FREE MEDICAL TREATMENT 1
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE 3
SHOULD NOT BE INVOLVED 4
OTHER (SPECIFY) ___ 6

811. If your relative is suffering from AIDS, who would you prefer to care for him/her?

RELATIVES 1
FRIENDS 2
GOVERNMENT ORGANIZATION 3
RELIGIOUS ORGANIZATION 4
NOBODY/ABANDON 5
OTHER (SPECIFY) ____ 6

812. Do you think your chances of getting AIDS are small, moderate, great, or that you have no risk at all?

SMALL 1
MODERATE 2
GREAT 3
NO RISK AT ALL 4
HAS AIDS 5
DON'T KNOW 8

813. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior? IF YES, PROBE: In what way?
RECORD ALL MENTIONED.

DID NOT START SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
STOPPED SEX WITH PROSTITUTES F
STOPPED HOMOSEXUAL CONTACTS G
OTHER (SPECIFY) _____ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DON'T KNOW Z

814. Have you heard of other diseases apart from AIDS which could be transmitted through sexual intercourse?

YES 1
NO 2 (GO TO 818)

815. Name the diseases. Any other?
CIRCLE ALL MENTIONED.

GONORRHEA A
SYPHILIS B
HERPES C
HEPATITIS D
OTHER (SPECIFY) ____ E

816. FOR EACH DISEASE MENTIONED IN Q.815 ASK THE FOLLOWING QUESTION AND CIRCLE ALL THE PLACES MENTIONED:
Where can a person go to treat (NAME OF DISEASE)? Anywhere else?

GONORRHEA

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____

SYPHILIS

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____

HERPES

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____

HEPATITIS

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____

OTHER

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____

817. Do you think your chances of getting sexually transmitted diseases (STDs), other than AIDS, are small, moderate, great, or that you have no risk at all?

SMALL 1
MODERATE 2
GREAT 3
NO RISK AT ALL 4
HAS STDs 5
DON'T KNOW 8

818. RECORD THE TIME.

HOUR ___
MINUTES ___

SECTION 9. HEIGHT AND WEIGHT

901. CHECK 233B:

ONE OR MORE CHILDREN SINCE JANUARY 1993 __
NO CHILDREN SINCE JANUARY 1993 __ (END)

IN 902 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1993 AND STILL ALIVE.
IN 903 AND 904 RECORD THE NAME (ALL COLUMNS) AND BIRTH DATE (COLUMNS 2, 3 AND 4) FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1993.

IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.

(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1993 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 3 LIVING CHILDREN SINCE JANUARY 1993, USE ADDITIONAL QUESTIONNAIRES).

902. LINE NO. FROM Q214

CHILD
_____

903. NAME FROM Q218 FOR CHILDREN

RESPONDENT
(NAME) _____
CHILD
(NAME) _____

904. DATE OF BIRTH FROM Q105 FOR RESPONDENT AND FROM Q220 FOR CHILDREN, AND ASK FOR DAY OF BIRTH

RESPONDENT
MONTH ___
YEAR 19__
CHILD
MONTH ___
YEAR 19__

905. BCG SCAR ON TOP OF SHOULDER

CHILD
SCAR SEEN 1
NO SCAR 2

906. HEIGHT (In centimetres)

RESPONDENT
______.__
CHILD
______.__

907. WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?

CHILD
LYING 1
STANDING 2

908. WEIGHT (In kilograms)

RESPONDENT
______.__
CHILD
______.__

909. LEFT UPPER ARM CIRCUMFERENCE (In centimeters)

RESPONDENT
______.__
CHILD
______.__

910. DATE WEIGHED AND MEASURED

RESPONDENT
DAY ___
MONTH ___
YEAR 19__
CHILD
DAY ___
MONTH ___
YEAR 19__

911. RESULT OF WEIGHING AND MEASURING

RESPONDENT (1)
MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) ____ 6
CHILD
MEASURED 1
CHILD SICK 2
NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ____ 6

912. NAME OF MEASURER: ______

NAME OF ASSISTANT: ______ ___

INTERVIEWER'S OBSERVATIONS
To be filled in after completing interview

Comments about Respondent:
______________________
______________________
______________________

Comments on Specific Questions:
______________________
______________________
______________________

Any Other Comments:
______________________
______________________
______________________

SUPERVISOR'S OBSERVATIONS
______________________
______________________
______________________

Name of Supervisor Date:

EDITOR'S OBSERVATIONS

Name of Editor: __________
Date: _____